The present invention relates to fracture bracing and, more particularly, to an improved fracture orthosis or brace of the type that permits ambulation of the patient having both a fracture and soft tissue damage.
Traditionally, fractures of the tibia have been treated with a toe-to-groin cast of plaster of paris. The cast immobilizes the ankle, leg, knee and thigh, thereby severely limiting the mobility of a typical patient. Lack of ambulation can lead to joint stiffening and muscle atrophy. Additionally, the cast is uncomfortable because of its weight, and the patient's inability to relieve itching.
It has been recognized that after an initial period with the toe-to-groin cast a special type of fracture brace or orthosis for tibia and fibula fractures can be used in place of toe-to-groin casts. This fracture brace extends from the foot to the knee and completely encases the involved leg in a rigid shell. An example of this type of fracture brace is described in U.S. Pat. No. 4,320,748 to Racette et al. Loads from the ambulation permitted by this type of fracture brace are transferred to the proximal part of the skeleton by the rigid shell, the encased musculature, and the involved tibia and fibula. It has been found that this load transfer can enhance osteogenesis. Any shortening of the involved leg with this technique is of the same magnitude as with the toe-to-groin cast. Any rotation or angulation of the involved bone is also of the same magnitude.
This prior fracture brace permits proximal joint use, and reduces muscle atrophy and the incidence of nonunion of the bones. In the past, the acuteness of the initial injury usually results in appreciable swelling, discomfort, and soft tissue damage for which a toe-to-groin cast would be necessary. The use of the prior fracture brace with soft tissue damage can result in unacceptable discomfort because of pressure on the damaged tissue. Therefore, the fracture brace would be used only after initial acute treatment in a toe-to-groin cast, or after the soft tissue damage has healed.
Toe-to-groin casts require removal to treat soft tissue damage, or to make adjustments necessary for the encapsulation required for the proper fit between the bone, cast, and soft tissue. However, once these casts are removed they cannot be reused. The prior fracture brace can be removed, adjusted, and reused, but it can only be used after soft tissue damage has healed. Therefore, there is a current need for a fracture orthosis or brace which can be used while soft tissue damage is healing.
The present invention is an orthosis which can be used for patients having both a fracture and soft tissue damage. The orthosis of the present invention provides a shell which is rigid enough to support a limb but does not exert excessive pressure to the damaged soft tissue which would cause discomfort. The orthosis of the present invention also provides ventilation to the limb thereby enabling the damaged soft tissue to heal properly and further allows for comfort while wearing the orthosis.